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Objetivo: analisar os registros perioperatórios baseados nas etapas de sistematização da assistência de enfermagem perioperatória em um hospital regional público do agreste de Pernambuco. Método: estudo transversal, descritivo, com abordagem quantitativa, obtido com dados secundários, conduzido em um hospital público. A amostra foi composta por 276 prontuários de indivíduos que se submeteram a procedimentos anestésico-cirúrgicos, durante os meses de janeiro a maio de 2023. Utilizou-se a análise descritiva e inferencial. Resultados: a efetuação dos registros da sistematização da assistência de enfermagem perioperatória foi predominante na maioria do período perioperatório, com respectiva significância principalmente no pré-operatório. Conclusão: as atividades satisfatórias corresponderam à visita pré-operatória de enfermagem, histórico, diagnóstico e prescrição de enfermagem. Já as fragilidades identificadas destacaram-se a ausência de reservas sanguíneas, a verificação de alergia e a colocação de placa de eletrocautério, inserção de sonda vesical, a efetuação do controle de perdas sanguíneas, fisiológicas e secreção gástrica.

Objective: analyzing perioperative records based on the phases of systematization of perioperative nursing care in a public regional hospital in Pernambuco's harsh region. Method: a cross-sectional, descriptive study with a quantitative approach, using secondary data, conducted in a public hospital. The sample consisted of 276 medical records of individuals who underwent anesthetic-surgical procedures between January and May 2023. Descriptive and inferential analysis was used. Results: the recording of the systematization of perioperative nursing care was predominant in the majority of the perioperative period, with significance mainly in the preoperative period. Conclusion: the satisfactory activities corresponded to the preoperative nursing visit, history, diagnosis, and nursing prescription. The weaknesses identified were the lack of blood reserves, checking for allergies and placing the electrocautery plate, inserting a urinary catheter, controlling blood loss, physiological loss, and gastric secretion.

Objetivo: analizar los registros perioperatorios a partir de las etapas de sistematización de la atención de enfermería perioperatoria en un hospital público regional de la zona rural de Pernambuco. Método: estudio descriptivo transversal, con enfoque cuantitativo, a partir de datos secundarios, realizado en un hospital público. La muestra estuvo compuesta por 276 historias clínicas de personas sometidas a procedimientos anestésico-quirúrgicos, de enero a mayo de 2023. Se utilizó análisis descriptivo e inferencial. Resultados: el registro de la sistematización de la atención de enfermería perioperatoria predominó en la mayor parte del periodo perioperatorio, con significación principalmente en el periodo preoperatorio. Conclusión: las actividades satisfactorias correspondieron a la visita de enfermería preoperatoria, registro, diagnóstico y prescripción de enfermería. Las debilidades identificadas incluyeron falta de reservas de sangre, comprobación de alergias y colocación de placa de electrocauterio, inserción de sonda vesical, control de la pérdida de sangre, fisiológica y secreción gástrica.

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Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

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BACKGROUND: Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS: A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS: Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION: High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.

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BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. METHODS: We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. RESULTS: The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. CONCLUSIONS: The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.

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This report provides a summary of childhood cancer and the efforts made in the Dominican Republic to address child and adolescent cancer in line with the World Health Organization's Global Initiative for Childhood Cancer. Information was obtained by review of recent local and international literature on pediatric oncology. As a result of the Global Initiative, a meeting was held by the Council of Ministers of Health of Central America to support the development of national pediatric cancer plans for each country. The objectives of these plans are to improve overall survival and quality of care for children with cancer through early detection, diagnosis, and treatment. In the Dominican Republic, several steps have been taken in the past 5 years to enhance diagnosis and care of children with cancer. For example, the National Committee of Childhood Cancer, headed by the Ministry of Public Health and including relevant stakeholders, was established to develop the national childhood cancer plan. In addition, a campaign was launched to raise awareness of childhood cancer, and the first early detection manual and public policy on child and adolescent cancer were published. A government initiative has been working to improve the hospital infrastructure and expand the pediatric cancer center, and a national course on early detection of pediatric cancers has been held. In 2023, the National Strategic Childhood Cancer Plan 2023-2030 was launched in the Dominican Republic. The plan will help policy-makers, implementers, researchers, and advocates enhance diagnosis and care of children with cancer.

En este informe se presenta un resumen del cáncer infantil y las medidas adoptadas por República Dominicana para abordar el cáncer en la población infantil y adolescente en consonancia con la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. La información se obtuvo mediante el análisis de las publicaciones nacionales e internacionales recientes sobre oncología pediátrica. Como resultado de la Iniciativa Mundial, el Consejo de Ministros de Salud de Centroamérica celebró una reunión para brindar apoyo a la elaboración de planes nacionales sobre el cáncer infantil para cada país. Los objetivos de estos planes son mejorar la supervivencia general y la calidad de la atención que se presta a la población infantil con cáncer mediante la detección temprana, el diagnóstico y el tratamiento. En los últimos cinco años, República Dominicana ha adoptado varias medidas para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer. Así, por ejemplo, se creó el Comité Nacional de Cáncer Infantil, encabezado por el Ministerio de Salud e integrado por las partes interesadas pertinentes, para elaborar el plan nacional sobre el cáncer infantil. Además, se puso en marcha una campaña de sensibilización sobre el cáncer infantil y se publicaron el primer manual de detección precoz y la primera política pública sobre el cáncer en la población infantil y adolescente. Mediante una iniciativa gubernamental se ha buscado mejorar la infraestructura hospitalaria y ampliar el centro de atención a pacientes oncológicos pediátricos, al tiempo que se ha impartido un curso nacional sobre detección precoz del cáncer infantil. En el 2023, República Dominicana puso en marcha el Plan Estratégico Nacional sobre Cáncer Infantil 2023-2030. Este plan será útil a los responsables de la formulación de políticas, las personas encargadas de su ejecución, los investigadores y los promotores para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer.

Este relatório fornece um resumo sobre o câncer infantil e os esforços da República Dominicana para enfrentar a doença em crianças e adolescentes, em consonância com a Iniciativa Global para o Câncer Infantil da Organização Mundial da Saúde. As informações foram obtidas por meio de uma revisão da literatura local e internacional recente sobre oncologia pediátrica. Em consequência da Iniciativa Global, o Conselho de Ministros da Saúde da América Central se reuniu para apoiar a elaboração de planos nacionais de câncer pediátrico para cada país. Os objetivos desses planos são melhorar a sobrevida global e a qualidade da atenção a crianças com câncer por meio de detecção, diagnóstico e tratamento precoces. Na República Dominicana, várias medidas foram tomadas nos últimos cinco anos para melhorar o diagnóstico e a atenção a crianças com câncer. Por exemplo, o Comitê Nacional de Câncer Infantil, que é chefiado pelo Ministério da Saúde e inclui as partes interessadas pertinentes, foi criado para elaborar o plano nacional de câncer infantil. Foi lançada uma campanha de conscientização sobre o câncer infantil no país. Além disso, foram publicados o primeiro manual de detecção precoce e a política pública de câncer infantojuvenil. Uma iniciativa do governo vem trabalhando para melhorar a infraestrutura hospitalar e ampliar o centro de câncer pediátrico e ministrou um curso nacional sobre a detecção precoce de cânceres pediátricos. Em 2023, foi lançado o Plano Estratégico Nacional de Câncer Infantil 2023­2030 na República Dominicana. O plano ajudará formuladores de políticas, implementadores, pesquisadores e defensores da causa a aprimorar o diagnóstico e a atenção a crianças com câncer.

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Introdução: Entre os desafios para se alcançar o cuidado integral está o acesso às unidades básicas, que não ocorre com tanta facilidade como deveria, caracterizando-se como uma grande dificuldade para os gestores municipais. O Programa de Melhoria ao Acesso e Qualidade de Atenção Básica, teve como objetivo incentivar a ampliação do acesso e melhorar a qualidade da atenção básica, garantindo um padrão de qualidade comparável nacionalmente, regionalmente e localmente de maneira a permitir maior transparência e efetividade das ações governamentais relacionadas a atenção básica. Objetivo: Avaliar a qualidade da atenção básica dos municípios da 6ª região de saúde, na perspectiva do acesso aos serviços de saúde. Metodologia: Trata-se de uma pesquisa avaliativa, com abordagem quantitativa. Foram utilizados dados secundários extraídos dos relatórios analíticos disponibilizados publicamente. A coleta dos dados ocorreu no período de março a maio de 2020. As informações foram organizadas a partir da elaboração de um protocolo de pesquisa contendo a dimensão: acesso. Resultados: Em relação ao acolhimento à demanda espontânea, 34 equipes não realizavam classificação de risco e 44 não realizavam acolhimento durante todo o funcionamento. Na análise dos indicadores de consulta médicas, identificou-se que 18 equipes não apresentaram resultados para os cálculos e não realizavam consultas médicas essenciais. Os dados evidenciaram que 40 equipes não agendavam consultas durante todo o horário e nana organização da agenda, apenas 9 equipes atenderam aos critérios descritos nas dimensões analisadas. Conclusões: Foi possível identificar que existem muitas barreiras organizacionais em relação ao acesso, principalmente quanto a marcação de consultas e ao acolhimento à demanda espontânea (AU).

Introduction: Among the challenges in achieving comprehensive care is access to basic units, which does not occur as easily as it should, representing a major difficulty for municipal managers. The Program for Improving Access and Quality of Primary Care aimed to encourage the expansion of access and improve the quality of primary care, ensuring a comparable quality standard nationally, regionally, and locally to allow greater transparency and effectiveness of government actions related to primary care.Objective:Evaluate the quality of primary care in the municipalities of the 6th health region, from the perspective of access to health services.Methodology: This is an evaluative research, with a quantitative approach. Secondary data extracted from publicly available analytical reports were used. Data collection took place from March to May 2020. The information was organized based on the development of a research protocol containing the dimension: access. Results: About welcoming spontaneous demand, 34 teams did not carry out risk classification and 44 did not provide support throughout the operation. In the analysis of medical consultation indicators, it was identified that 18 teams did not present results for the calculations and did not carry out essential medical consultations. The data showed that 40 teams did not schedule appointments during all hours and when organizing the agenda, only 9 teams met the criteria described in the dimensions analyzed. Conclusions:It was possible to identify that there are many organizational barriers to access, mainly regarding scheduling appointments and accepting spontaneous demand (AU).

Introducción: Entre los desafíos para alcanzar el cuidado integral está el acceso a las unidades básicas, que no ocurre con tanta facilidad como debería, caracterizándose como una grandificultad para los gestores municipales. El Programa de Mejora al Acceso y Calidad de Atención Básica, tuvo como objetivo incentivar la ampliación del acceso y mejorar la calidad de la atención básica, garantizando un estándar de calidad comparable nacionalmente, regionalmente y local de manera a permitir mayor transparencia y efectividad de las acciones gubernamentales relacionadas con la atención básica.Objetivo: Evaluar la calidad de la atención primaria en los municipios de la 6ª región sanitaria desde la perspectiva del acceso a los servicios sanitarios.Metodología: Se trata de una investigación evaluativa, con enfoque cuantitativo. Se utilizaron datos secundarios extraídos de informes analíticos disponibles públicamente. La recolección de datos se realizó de marzo a mayo de 2020. La información se organizó a partir del desarrollo de un protocolo de investigación que contiene la dimensión: acceso.Resultados: En relación al acogimiento a la demanda espontánea, 34 equipos no realizaban clasificación de riesgo y 44 no realizaban acogida durante todo el funcionamiento. En el análisis de los indicadores de consulta médicas, se identificó que 18 equipos no presentaron resultados para los cálculos y no realizaban consultas médicas esenciales. Los datos evidenciaron que 40 equipos no programaban consultas durante todo el horario y en la organización de la agenda, solo 9 equipos atendieron a los criterios descritos en las dimensiones analizadas. Conclusiones: Fue posible identificar que existen muchas barrerasorganizacionales en relación al acceso, principalmente en cuanto a la marcación de consultas y a la acogida a la demanda espontánea (AU).

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Introduction: Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer. The objective of this research is to describe the perception of knowledge and communications practices used by oncology doctors with respect to sexual health in the care of their patients, as well as the barriers found when it comes to confronting the topic. Methods: An exploratory quantitative, descriptive and cross-sectional study was carried out, in which a self-administered questionnaire was given to oncology doctors who practise in Chile. This questionnaire had 41 closed questions with answers on a Likert scale and was previously validated by being reviewed and applied to a pilot group of five professionals (one medical bioethics expert and four doctors in the field of oncology). The data were analysed with the SPSS statistical program v. 20, using descriptive statistics. Results: The main results show that the surveyed doctors consider sexuality to be an important part of patients' quality of life. However, this finding does not align with the practices given for including it as part of clinical care. The professionals refer as the main barriers those that are attributed to the structural functioning of the institution, giving little value to those barriers related to personal aspects or those associated with patient characteristics and/or behaviors. Conclusion: The results of this study show that, despite oncology doctors seeing sexuality as an important aspect of the quality of life of their patients, they do not include the topic in clinical care. Given that one of the main barriers is obstacles relating to the institution, it is necessary to create political institutions that create the conditions for including this area as a relevant part of cancer patient care.

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[This corrects the article DOI: 10.3389/fnut.2023.1278280.].

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Objective: Demonstrate whether a multiprofessional Clinical Pathway Program in Total Knee Arthroplasty (CPPA) contributesto optimizing hospital care. Method: Retrospective study of medical data of care indicators in 310 patients divided into two groups: A- who underwent arthroplasty in the last biennium before the introduction of the CPPA (n=144) and group B- who underwent TKA in the biennium after the introduction of the CPPA (n=166). Results: Postoperative showed a significant difference in favor of group B over group A for hospitalization time in days 4.33 ± 2.79 and 5.4 ± 1.67 (p<0.001), time of prophylactic antibiotic in hours 28.13 ± 33.77 and 81.49 ± 40.91 (p<0.001), referral to the intensive care unit 40.9% and 73.4% (p<0.001), initiation of thromboprophylaxis within 24 hours 97.9% and 82.5% (p<0.001), use of elastic stockings and/or intermittent compression prescribed for thromboprophylaxis 89.5% and 31.2% (p<0.001), initiation of rehabilitation within 24 hours 90.1% and 66.1% (p<0.001), readmissions within 30 days 4.1% and 3% (p = 0.76), readmissions 90 days 2.7% and 6.6% (p = 0.183), transfusions 5.5% and 15.2% (p = 0.033). Conclusion: The implementation of a multiprofessional CPPA contributed to the implementation of care protocols, favoring greater patient safety. Level of Evidence III; Retrospective Comparative Study.

Objetivo: Demonstrar se um Programa de Cuidados Clínicos multiprofissional em Artroplastia Total de Joelho (PCCA) contribui para a otimização assistencial hospitalar. Método: Estudo retrospectivo em prontuários de indicadores assistenciais em 310 pacientes divididos em dois grupos: A- submetidos a artroplastia no último biênio antecessor a introdução do PCCA (n=144) e grupo B- submetidos a ATJ no biênio após a introdução do PCCA (n=166). Resultados: Indicadores pós-operatórios mostraram diferença significativa a favor do grupo B sobre o grupo A para tempo de hospitalização em dias 4,33 ± 2,79 e 5,4 ± 1,67 (p<0,001), tempo de antibiótico profilático em horas 28,13 ± 33,77 e 81,49 ± 40,91 (p<0,001), encaminhamento para unidade de terapia intensiva 40,9% e 73,4% (p<0,001), início da tromboprofilaxia dentro de 24h 97,9% e 82,5% (p<0,001), uso de meias elásticas e/ou compressão intermitente prescritos para tromboprofilaxia 89,5% e 31,2% (p<0,001), tempo para iniciação da reabilitação em 24h 90,1% e 66,1% (p<0,001), readmissões em 30 dias 4,1% e 3% (p = 0,76), readmissões 90 dias 2,7% e 6,6% (p = 0,183), transfusões 5,5% e 15,2% (p = 0,033). Conclusão: A implementação de um PCCA multiprofissional contribuiu para o cumprimento dos protocolos assistenciais favorecendo maior segurança para os pacientes. Nível de Evidência III; Estudo Retrospectivo Comparativo.

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The objective of this study is to compare and contrast the quality statements and quality indicators across clinical care standards for low back pain. Searches were performed in Medline, guideline databases, and Google searches to identify clinical care standards for the management of low back pain targeting a multidisciplinary audience. Two independent reviewers reviewed the search results and extracted relevant information from the clinical care standards. We compared the quality statements and indicators of the clinical care standards to identify the consistent messages and the discrepancies between them. Three national clinical care standards from Australia, Canada, and the United Kingdom were included. They provided from 6 to 8 quality statements and from 12 to 18 quality indicators. The three standards provide consistent recommendations in the quality statements related to imaging, and patient education/advice and self-management. In addition, the Canadian and Australian standards also provide consistent recommendations regarding comprehensive assessment, psychological support, and review and patient referral. However, the three clinical care standards differ in the statements related to psychological assessment, opioid analgesics, non-opioid analgesics, and non-pharmacological therapies. The three national clinical care standards provide consistent recommendations on imaging and patient education/advice, self-management of the condition, and two standards (Canadian and Australian) agree on recommendations regarding comprehensive assessment, psychological support, and review and patient referral. The standards differ in the quality statements related to psychological assessment, opioid prescription, non-opioid analgesics, and non-pharmacological therapies.

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This study aimed to analyze early revisits (within 48 hours of discharge) in an Emergency Department. Among the 178,295 visits, 11,686 were revisits, resulting in a rate of 6.55% (95%CI 6.43-6.67). A total of 1,410 revisits required hospitalization, and 252 were due to preventable errors (17.87%). These errors were mainly related to an inadequate therapeutic plan at discharge (47.22%), an incomplete diagnostic process (29.37%), and misdiagnoses (13.10%). These findings represent a technology-enabled clinical audit tool. Electronic Healthcare Records have the potential to: provide quality metrics of hospital performance, help to keep revisit rates updated (assessment through a real-time dashboard), and improve clinical management (by transparency initiatives about errors, and a supportive learning environment regarding lessons learned).

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OBJECTIVE: To systematically synthesize studies that analyze the relationship between a healthy practice environment and quality of nursing care in hospital settings; to identify the most commonly used instruments to assess nurses' perceptions of a healthy practice environment; to identify the most commonly used instruments to assess nurses' perceptions of quality of nursing care. METHOD: A systematic literature review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search will be conducted in the principal databases. Review of international scientific articles published in the last ten years, accessed through the database of the Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, on nurses' perceptions of the influence of the environment on healthy nursing practice and quality of care. Inclusion: Articles published after 2012 in Portuguese, Spanish, and English. The identified, selected and included studies will be highlighted for the selection process using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). If possible, quantitative data will be pooled into a meta-analysis using the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI).

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Avaliou-se a qualidade da atenção pré-natal na Estratégia Saúde da Família (ESF) em município de referência macrorregional do Nordeste brasileiro. Trata-se de avaliação normativa com nível analítico centrado nas Equipes de Saúde da Família (eSF). Realizaram-se entrevistas com enfermeiros gerentes das eSF, mediante um questionário estruturado, validado nacionalmente e com padrões avaliativos da estrutura e do processo de trabalho das eSF, centrado nas dimensões assistencial e gerencial. Foi feita análise descritiva, considerando a frequência de adequação das equipes a cada padrão avaliativo. Nove (69,9%) eSF avaliadas atendiam satisfatoriamente aos padrões de qualidade na atenção pré-natal e quatro (31,0%) atendiam regularmente. Na dimensão gerencial, os atributos de processos de trabalho foram os mais críticos de adequação; e na dimensão assistencial, os atributos de estrutura tiveram maior dificuldade de alcançar a adequação aos padrões de qualidade do pré-natal. Este estudo contribuiu para identificar os principais obstáculos e potencialidades da estrutura e dos processos gerenciais e assistenciais da atenção pré-natal. Os achados revelaram quais são os padrões mais críticos de adequação e que demandam dos gestores municipais e gerentes locais estratégias de melhoria da qualidade na atenção pré-natal.

This normative study evaluated the quality of prenatal care offered by the Family Health Strategy in a macro-regional reference municipality in northeastern Brazil focusing on the Family Health Teams (eSF). Interviews were conducted with eSF nurse managers using a validated structured questionnaire with evaluative standards of the eSF structure and work process, focused on the care and management dimensions. Data underwent descriptive analysis, considering the frequency of team adaptation to each evaluative standard. Nine (69.0%) of the eSF evaluated satisfactorily met quality standards in prenatal care and four (31,0%) provided regular care. Regarding management, work process attributes were the most critical for adequacy; in care, structure attributes showed greater difficulty in achieving adequacy to prenatal quality standards. This study identified the main obstacles and potentialities of prenatal care structure and management. The findings revealed which are the most critical adequacy standards and which require from municipal and local managers strategies for improving the quality of prenatal care.

Se evaluó la calidad de la atención prenatal en la Estrategia de Salud de la Familia (ESF) en un municipio macrorregional de referencia del Nordeste brasileño. Esta es una evaluación normativa con nivel analítico centrado en los Equipos de Salud de la Familia (eSF). Se realizaron entrevistas a enfermeras gestoras de los eSF, a través de un cuestionario estructurado, validado a nivel nacional y con estándares evaluativos de la estructura y del proceso de trabajo de los eSF, centrado en las dimensiones asistencial y gerencial. Se realizó un análisis descriptivo, considerando la frecuencia de adaptación de los equipos a cada estándar evaluativo. Nueve (69,0%) eSF evaluados cumplieron satisfactoriamente con los estándares de calidad en la atención prenatal, y cuatro (31,0%) brindaron atención regular. En la dimensión gerencial, los atributos del proceso de trabajo fueron los más críticos para la adecuación; y en la dimensión de atención, los atributos de estructura tuvieron mayor dificultad para lograr la adecuación a los estándares de calidad prenatal. Este estudio contribuyó a identificar los principales obstáculos y potencialidades de la estructura y de los procesos de gestión y atención prenatal. Los resultados revelaron cuáles son los estándares de adecuación más críticos y cuáles exigen de los gestores municipales y locales estrategias para mejorar la calidad de la atención prenatal.

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Introducción. Los Servicios de Salud Amigables son espacios de atención integral y diferencial para personas adolescentes y jóvenes, que parten de sus necesidades biológicas, sociales y afectivas. Objetivo. Evaluar las percepciones de las juventudes sobre la calidad de atención que recibieron y su experiencia en las Unidades de Salud. Metodología. Se realizó un estudio mixto que recogió las percepciones de los participantes en dos etapas sucesivas. Primero, con un cuestionario se evaluó la calidad de atención y experiencia de los usuarios; luego, mediante entrevistas grupales e individuales se estimó el nivel de satisfacción. Resultados. El 68,2 % de los jóvenes y adolescentes desconocen los programas exclusivos para ellos. El servicio más utilizado es el de medicina general (76,6 %). En cuanto a la atención recibida, el respeto, la confianza y la privacidad brindada por los profesionales de salud fue calificada como excelente o muy buena (76 %). El 39,7 % reportó que el tiempo de espera fue de 30 a 60 minutos; el 17,6 % refirió esperar más de dos horas. Conclusión. Aunque la percepción de las unidades de salud por parte de los adolescentes y jóvenes en general es buena, los Servicios de Salud Amigables cuentan con barreras que interfieren en el acceso, oportunidad y aceptabilidad

Introduction. Friendly Health Services are spaces of comprehensive and differential care for adolescents and young people, which start from their biological, social and emotional. Objective. Evaluate the perceptions of youth about the quality of care they received and their experience in the Community Family Health Units. Methodology. A mixed study was carried out that collected the perceptions of the participants in two successive stages. First with a questionnaire that evaluated the quality of care and experience of users, then through group and individual interviews that estimated the level of satisfaction. Results. Youth consult health establishments, although 68.2 % are unaware of the exclusive programs for them (Friendly Health Services). The most used service was general medicine (76.6 %). Regarding the care received, the respect, trust and privacy provided by health professionals was rated as excellent or very good (76 %). 39.7 % reported that the waiting time was 30 to 60 minutes, 17.6 % reported waiting more than two hours. Conclusion. Currently, there is a need to improve access to services for adolescents and young people by socializing the offer to encourage their use, increase attention in preventive areas and implement their evaluation with methods different from current ones

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OBJECTIVE: The aim of this study was to determine the factors associated with negative birth experience in Peruvian Quechua-speaking indigenous women in the context of contagion due to COVID-19. METHODS: This was a cross-sectional study, with 142 women from the Olleros community (Huaraz-Peru, 3336 m a.s.l.), whose birth occurred between November 2020 and December 2021. Two questionnaires were applied between January and June 2022, prior voluntary informed consent and approval by an ethics committee. The SPSS program version 24 and the odds ratio (OR) were used with 95% confidence interval (CI). RESULTS: A total of 62.7% of women (89/142) had a negative birth experience. The main factors associated were hospital and biosafety factors, highlighting the restriction to choose the position during birth (OR = 15.64, CI: 1.89-128.99, P = 0.001), care of women in a language other than Quechua (OR = 5.86, CI: 1.51-22.76, P = 0.005) and fear of health personnel when approaching women due to COVID-19 (OR = 10.61, CI: 3.94-28.56, P < 0.001). CONCLUSION: Hospital and biosafety factors are associated with negative birth experience in Peruvian Quechua-speaking indigenous women, with less emphasis on sociodemographic and obstetric factors. The results found show that, in the case of this research, the negative birth experience is not only due to the restrictions imposed by COVID-19 pandemic, but also to the limited application of the intercultural approach in Peru, where the opinion of women is not taken into account. In this sense, intervention actions are required through health policies with an intercultural approach that involve the active participation of women.

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ABSTRACT Objective: Demonstrate whether a multiprofessional Clinical Pathway Program in Total Knee Arthroplasty (CPPA) contributesto optimizing hospital care. Method: Retrospective study of medical data of care indicators in 310 patients divided into two groups: A- who underwent arthroplasty in the last biennium before the introduction of the CPPA (n=144) and group B- who underwent TKA in the biennium after the introduction of the CPPA (n=166). Results: Postoperative showed a significant difference in favor of group B over group A for hospitalization time in days 4.33 ± 2.79 and 5.4 ± 1.67 (p<0.001), time of prophylactic antibiotic in hours 28.13 ± 33.77 and 81.49 ± 40.91 (p<0.001), referral to the intensive care unit 40.9% and 73.4% (p<0.001), initiation of thromboprophylaxis within 24 hours 97.9% and 82.5% (p<0.001), use of elastic stockings and/or intermittent compression prescribed for thromboprophylaxis 89.5% and 31.2% (p<0.001), initiation of rehabilitation within 24 hours 90.1% and 66.1% (p<0.001), readmissions within 30 days 4.1% and 3% (p = 0.76), readmissions 90 days 2.7% and 6.6% (p = 0.183), transfusions 5.5% and 15.2% (p = 0.033). Conclusion: The implementation of a multiprofessional CPPA contributed to the implementation of care protocols, favoring greater patient safety. Level of Evidence III; Retrospective Comparative Study.

RESUMO Objetivo: Demonstrar se um Programa de Cuidados Clínicos multiprofissional em Artroplastia Total de Joelho (PCCA) contribui para a otimização assistencial hospitalar. Método: Estudo retrospectivo em prontuários de indicadores assistenciais em 310 pacientes divididos em dois grupos: A- submetidos a artroplastia no último biênio antecessor a introdução do PCCA (n=144) e grupo B- submetidos a ATJ no biênio após a introdução do PCCA (n=166). Resultados: Indicadores pós-operatórios mostraram diferença significativa a favor do grupo B sobre o grupo A para tempo de hospitalização em dias 4,33 ± 2,79 e 5,4 ± 1,67 (p<0,001), tempo de antibiótico profilático em horas 28,13 ± 33,77 e 81,49 ± 40,91 (p<0,001), encaminhamento para unidade de terapia intensiva 40,9% e 73,4% (p<0,001), início da tromboprofilaxia dentro de 24h 97,9% e 82,5% (p<0,001), uso de meias elásticas e/ou compressão intermitente prescritos para tromboprofilaxia 89,5% e 31,2% (p<0,001), tempo para iniciação da reabilitação em 24h 90,1% e 66,1% (p<0,001), readmissões em 30 dias 4,1% e 3% (p = 0,76), readmissões 90 dias 2,7% e 6,6% (p = 0,183), transfusões 5,5% e 15,2% (p = 0,033). Conclusão: A implementação de um PCCA multiprofissional contribuiu para o cumprimento dos protocolos assistenciais favorecendo maior segurança para os pacientes. Nível de Evidência III; Estudo Retrospectivo Comparativo.

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Os enfermeiros que atuam na assistência hospitalar lidam com dor física, emocional, situações de alta complexidade, exposição ao sofrimento, medo, estresse e ansiedade, o que favorece o desenvolvimento da fadiga por compaixão, que é considerada uma forma de sofrimento decorrente da atividade laboral e pode comprometer a saúde e bem-estar do enfermeiro, bem como a segurança do paciente. Objetivou-se relacionar a fadiga por compaixão com aspectos da qualidade da assistência à saúde e segurança do paciente. Tratou-se de um estudo exploratório, quantitativo, correlacional, realizado entre maio e junho de 2021. A coleta de dados ocorreu por meio de questionário online após anuência do Comitê de Ética em Pesquisa e consentimento dos participantes. A amostra constituiu-se de 410 enfermeiros que atuavam em três hospitais privados de São Paulo; 319 (78%) eram do sexo feminino, 212 (51,71%) atuavam de 4 a 10 anos nos hospitais. Obteve-se correlações positivas entre índices elevados na dimensão de fadiga por compaixão e burnout do questionário ProQol-Br e aspectos relacionados à qualidade assistencial e segurança do paciente (p<0,001). Os enfermeiros concordaram que devido à sobrecarga de trabalho e exaustão mental deixaram de cumprir integralmente protocolos de qualidade e segurança do paciente, o que pode aumentar a ocorrência de eventos adversos. Evidenciou se a relevância de desenvolvimento de estratégias para melhorar a sobrecarga de trabalho, por meio da adequação dos recursos humanos, satisfação e reconhecimento profissional, a fim de minimizar à ocorrência de fadiga por compaixão e repercutir positivamente na qualidade assistêncial e segurança do paciente.

Nurses who work in hospital care deal with physical and emotional pain, highly complex situations, exposure to suffering, fear, stress and anxiety, which favors the development of compassion fatigue, which is considered a form of suffering resulting from work activity. and can compromise the health and well-being of nurses, as well as patient safety. The objective was to relate compassion fatigue with aspects of the quality of healthcare and patient safety. This was an exploratory, quantitative, correlational study, carried out between May and June 2021. Data collection took place through an online questionnaire after approval from the Research Ethics Committee and consent from the participants. The sample consisted of 410 nurses who worked in three private hospitals in São Paulo; 319 (78%) were female, 212 (51.71%) had worked in hospitals for 4 to 10 years. Positive correlations were obtained between high rates in the compassion fatigue and burnout dimension of the ProQol-Br questionnaire and aspects related to quality of care and patient safety (p<0.001). The nurses agreed that due to work overload and mental exhaustion, they failed to fully comply with quality and patient safety protocols, which could increase the occurrence of adverse events. The relevance of developing strategies to improve work overload was highlighted, through the adequacy of human resources, satisfaction and professional recognition, in order to minimize the occurrence of compassion fatigue and have a positive impact on the quality of care and patient safety.

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Objetivos: avaliar a cultura de segurança do paciente na percepção de trabalhadores de enfermagem e identificar a associação dessa cultura com variáveis sociodemográficas e profissionais dos trabalhadores. Método: estudo transversal, com abordagem quantitativa, desenvolvido em hospital público geral de Salvador, Bahia, Brasil, com 180 trabalhadores de enfermagem. Foi empregado o questionário Hospital Survey on Patient Safety Culture e utilizou-se estatística descritiva, testes de associação e de correlação para análise dos dados. Resultados: nenhuma dimensão da cultura foi considerada fortalecida, a nota de segurança foi classificada como regular por 58,0% dos trabalhadores e 63,9% revelaram não efetuar notificação no último ano. A cultura esteve associada ao sexo, à categoria profissional, ao tipo e à quantidade de vínculo trabalhista, ao local de trabalho, à idade e à experiência profissional e no serviço. Conclusão: a cultura revelou-se fragilizada apontando para necessidade de intervenções, especialmente no que tange aos fatores associados.

Objetivos: evaluar la cultura de seguridad del paciente en la percepción de trabajadores de enfermería e identificar la asociación de esa cultura con variables sociodemográficas y profesionales de los trabajadores. Método: estudio transversal, con abordaje cuantitativo, desarrollado en hospital público general de Salvador, Bahía, Brasil, con 180 trabajadores de enfermería. Se empleó el cuestionario Hospital Survey on Patient Safety Culture y se utilizó estadística descriptiva, pruebas de asociación y de correlación para el análisis de los datos. Resultados: ninguna dimensión de la cultura fue considerada fortalecida, la nota de seguridad fue clasificada como regular por 58,0% de los trabajadores y 63,9% revelaron no efectuar notificación en el último año. La cultura estuvo asociada al sexo, a la categoría profesional, al tipo y a la cantidad de vínculo laboral, al lugar de trabajo, a la edad y a la experiencia profesional y en el servicio. En conclusión: la cultura se ha mostrado debilitada señalando la necesidad de intervenciones, especialmente en lo que respecta a los factores asociados.

Objectives: to evaluate the patient safety culture in the perception of nursing workers and to identify the association of this culture with sociodemographic and professional variables of workers. Method: cross-sectional study with a quantitative approach, developed in a general public hospital in Salvador, Bahia, Brazil, with 180 nursing workers. The Hospital Survey on Patient Safety Culture questionnaire was used and descriptive statistics, association and correlation tests were used to analyze the data. Results: no dimension of the culture was considered strengthened, the safety grade was classified as acceptable by 58.0% of the workers and 63.9% revealed no notification in the last year. Culture was associated with gender, professional category, type and amount of employment, workplace, age and professional and service experience. Conclusion: the culture proved to be fragile pointing to the need for interventions, especially regarding the associated factors.

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Introducción: La búsqueda continua de la mejora de la atención de enfermería conlleva la aplicación de instrumentos contemporáneos. Objetivo: Identificar buenas prácticas para la mejora de procesos relacionados con la calidad de la atención de enfermería en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Métodos: Se realizó un proyecto de desarrollo tecnológico, descriptivo, que empleó las tecnologías gerenciales de referenciación competitiva y gestión por procesos entre el 2018-2021. La institución de referencia fue la Clínica Central "Cira García". El grupo de estudio quedó conformado por personal vinculado a los procesos. Para la recolección de la información se diseñaron 10 instrumentos que se validaron con expertos por el método de Barraza. El estudio de los procesos de urgencias, esterilización y hospitalización se realizó en dos momentos: en el "Ramón Pando Ferrer" con el empleo de la metodología Lean y en la institución de referencia para conocer las buenas prácticas. Para el procesamiento de la información se utilizó la metodología planteada por Rodríguez y de Souza, para ello se tuvo en cuenta el referencial teórico del enfoque Lean y el de la referenciación competitiva. Resultados: Se identificaron mudas como espera, movimiento, sobreprocesamiento y defecto, se confeccionaron los diagramas de flujo y se identificaron indicadores de calidad. Conclusión: El procedimiento utilizado mostró resultados satisfactorios que evidencian la aplicabilidad de la integración de tecnologías en la identificación e incorporación de buenas prácticas(AU)

Introduction: The continuous search for the improvement of nursing care leads to the application of contemporary instruments. Objective: To identify good practices for the improvement of processes related to the quality of nursing care at Instituto Cubano de Oftalmología Ramón Pando Ferrer. Methods: A descriptive technological development project was carried out between 2018-2021, using the managerial technologies of competitive benchmarking and process management. The reference institution was Clínica Central Cira García. The study group was made up of personnel involved in the processes. For the collection of information, 10 instruments were designed and validated with experts by the Barraza method. The study of the emergency, sterilization and hospitalization processes was carried out in two stages: at the Ramón Pando Ferrer institution, with the use of the Lean methodology; and at the reference institution, to learn about good practices. The methodology proposed by Rodriguez and de Souza was used to process the information; also taking into account the theoretical referential of the Lean approach and that of competitive benchmarking. Results: Shortfalls were identified, such as waiting, movement, overprocessing and defect. Flow charts were drawn up and quality indicators were identified. Conclusion: The used procedure showed satisfactory results that demonstrate the applicability of integrating technologies in the identification and incorporation of good practices(AU)

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Resumen Objetivo validar el instrumento de cuidado perdido de enfermería (MISSCARE), para ser utilizado en contexto chileno. Método adaptación sociolingüística de MISSCARE a través de traducción y retrotraducción, seguida por evaluación de profesionales de enfermería con manejo de idioma inglés y finalmente validación de contenido a través de revisión, adecuación cultural y de contenido, por expertos del área. Resultados el instrumento en su versión 2.0 demostró validez aparente y de contenido. El cuidado de enfermería perdido es un evento adverso que amenaza la seguridad y calidad de la atención en salud. Contar con un instrumento validado que mida el cuidado perdido será un indicador para mejorar la calidad en la atención prestada. Conclusiones e implicaciones para la práctica el instrumento MISSCARE en su versión adaptada es una herramienta confiable y válida para medir el cuidado perdido en instituciones hospitalarias. Estudiar los cuidados omitidos generará conocimientos clave para mejorar la calidad de la atención en salud y desarrollar indicadores de gestión. Estos conocimientos impulsarán estrategias e intervenciones para optimizar servicios y garantizar un estándar más alto en la atención.

Resumo Objetivo validar o instrumento MISSCARE para uso no contexto chileno. Método a adaptação sociolinguística do MISSCARE envolveu tradução e retrotradução, seguida por avaliação de enfermeiros falantes de inglês. Finalmente, a validação de conteúdo foi alcançada por meio de revisão por especialistas, com foco na adaptação cultural e de conteúdo. Resultados a versão 2.0 do MISSCARE demonstrou validade de face e de conteúdo. O cuidado perdido é um evento adverso que ameaça a segurança e a qualidade da assistência à saúde. Ter um instrumento validado para medir o cuidado perdido servirá como um indicador para melhorar a qualidade da assistência à saúde prestada. Conclusão e implicações para a prática a versão adaptada do MISSCARE é uma ferramenta confiável e válida para medir o cuidado de enfermagem perdido em hospitais. O estudo do cuidado de enfermagem perdido gerará conhecimento essencial para melhorar a qualidade da assistência à saúde e desenvolver indicadores de gestão. Esses insights impulsionarão estratégias e intervenções para otimizar os serviços e garantir um padrão mais elevado de atendimento.

Abstract Objective to validate the MISSCARE instrument for use in the Chilean context. Method sociolinguistic adaptation of MISSCARE involved translation and back-translation, followed by evaluation by English-speaking nurses. Finally, content validation was achieved through expert review, focusing on cultural and content adaptation. Results the 2.0 version of MISSCARE demonstrated both face and content validity. Missed care is an adverse event that threatens the safety and quality of health care. Having a validated instrument to measure missed care will serve as an indicator to improve the quality of health care provided. Conclusions and implications for practice the adapted version of MISSCARE is a reliable, valid tool for measuring missed nursing care in hospitals. The study of missed nursing care will generate essential knowledge to improve the quality of health care and to develop management indicators. These insights will drive strategies and interventions in order to optimize services and ensure a higher standard of care.

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